Reaction to leg break in NCAA tournament rooted in evolution?

If you had a serious case of the heebie-jeebies when University of Louisville sophomore guard Kevin Ware snapped his tibia on live television during the NCAA basketball tournament, you weren’t alone.

Teammates crumpled to the floor. Players on the nearby bench physically recoiled. Louisville Coach Rick Pitino says he nearly vomited at the sight of his player’s bone jutting through the skin of his lower leg. Broadcasters stopped showing the break after a few replays.

Their reaction may be rooted in evolution, genetics and upbringing. Probably all three.

What happened, collectively, was the brain’s natural resonse to a trauma -- tamping down on blood flow, psychologists and physicians say. If the reaction is strong enough, the brain doesn’t get enough blood, and out go the lights. Technically: Vasovagal syncope has occurred.

“It’s a very common response,” said Bruce Thyer, a Florida State University psychologist. “This is something that happens to everyone at least to a minor degree.”

Those who faint at the sight of blood or hypodermic needles can testify to the disruptive force of vasovagal syncope, but the phenomenon may well be rooted in survival.

“It’s got undeniable evolutionary components,” Thyer said. “If an ancestor of ours was wounded and bleeding and they ran away, they were likely to bleed to death, but if they laid down and gave the blood time to coagulate, they had a better chance of survival.”

Thyer spent five years studying phobias, including blood phobia, at the University of Michigan. “I’ve had people get woozy hearing an ambulance,” he said. At such an extreme, the vasovagal response can lead people to avoid necessary medical care, from simple injections to surgery.

But back to the basketball game. Much was at stake, and the score was close, with Duke and Louisville tring to advance to the Final Four. Ware leaped for the ball, came down awkwardly, and his tibia snapped. His cries of pain could be heard by anyone nearby, and the bone was visibly protruding through his skin. The stage was set for a reaction to trauma.

“Picture these basketball players – they’re really pumped up, their adrenalin is pumping, and then they pause and see this player injured,” said Thyer said. “These guys are already pumped up and their body is trying to drive it down…. They’re more set up for a fainting response.”

No one appeared to faint, but at least one player put his head between his knees – keeping blood flowing to his brain. Ware never lost consciousness, and he reportedly reassured players that he would be fine. But the facial expressions and tears among players and coaches suggested it was not so easy to shake this one off.

“We see violent movies all the time but we know this is makeup, this is special effects,” Thyer said. “This is a guy they’re close to, and it’s a real, adrenalin-charged event.”

Most people recover from a vasovagal response without fainting, according to medical literature. But serious blood phobias can lead people to avoid needed healthcare that involves exposure to blood.

Fainting and wooziness tend to run in families, although the interplay of genetics and socialization is unclear, Thyer said. "It may be if you see mom or dad fainting or having a bad reation to a movie, you could pick it up from that."

Luckily, full-on blood phobia is treatable through fairly common methods, particularly real-life gradual exposure therapy. For instance, a client may lie on a sofa with a remote control, watching a medical procedure, and stop the footage when he feels faint. Eventually, that client can watch longer, and watch while sitting up, and eventually, standing.

So, maybe you’ll eventually be able to watch a replay. But try it lying down first.